The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
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Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.
In the therapeutic community (TC) perspective, the substance abuse disorder is not distinct from the substance abuser. A picture of dysfunction and disturbance of individuals entering treatment reflects a more fundamental disorder of the whole person. This chapter presents the TC view of the disorder in the context of current biomedical, social, and psychological understanding of chemical dependency. Overall, the picture that individuals present when entering the TC is one of health risk and social crises. In the TC perspective, drug abuse is a disorder of the whole person, affecting some or all areas of functioning. In the TC view, social and psychological factors are recognized as the primary sources of the addiction disorder. Substance abusers themselves cite a variety of reasons and circumstances as causes of their drug use. TC policy on the use of pharmacotherapy is currently undergoing modifications.
This chapter presents sets of questionnaires are helpful in working with fertility treatment. Infertility clients often carry within them a strong sense of blame and misplaced personal responsibility. The two primary negative cognitions that appear most often are: “There’s something wrong with me”, and “I must have done something wrong”. The chapter also presents a construction of a Time Line. Each Time Line corresponds to only one theme: responsibility, trust or control. It is important that the client have general information about the Adaptive Information Processing (AIP) Model in order to ensure optimum participation in treatment. The client is informed about what to expect relative to the process and effects of Eye Movement Desensitization and Reprocessing (EMDR). Based on client needs, risk considerations may include: poor self-care and nutrition, side effects of hormone or drug therapy consistent with fertility treatment, marital strain, or weakness in support system.
This chapter provides a brief description on evaluation and treatment of lung and bronchus cancer. An estimated 234,030 cases of lung cancer will occur in 2018, accompanied by an estimated 155,870 deaths from the disease. Lung cancer is the second most common cancer in men and women but is the leading cause of cancer mortality in both. This chapter discusses epidemiology, pathology, screening, diagnosis, and prevention of lung cancer. Paraneoplastic syndromes are a combination of symptoms produced by substances formed by the tumor or produced by the body in response to the tumor. Lung carcinoma is a pathologically heterogeneous tumor. The most important distinction is between small cell carcinoma and non-small cell carcinoma. Treatment for early-stage disease usually involves one or more modalities of treatment, which include surgery, chemotherapy, and radiation therapy. Patients with advanced disease are treated with chemotherapy, immunotherapy, or targeted therapy.
Breast cancer is the most common cause of cancer among women in the United States, with approximately 260,000 new cases of breast cancer and more than 40,000 breast cancer related deaths anticipated in 2018. Fortunately, an improved understanding of the importance of tumor biology has led to significant advances in the management of breast cancer in both the adjuvant and metastatic settings, as well as an improvement in patient morbidity and breast cancer specific survival. When an abnormality is detected on screening, breast cancer diagnosis and management typically require a multidisciplinary approach that incorporates some combination of radiology, surgery, pathology, medical oncology, radiation oncology, and/or specialists in rehabilitation. This chapter provides an overview of the principles of using systemic therapy (i.e., medications that are absorbed and carried throughout the bloodstream, such as chemotherapy and endocrine therapy) for the management of breast cancer.
This chapter addresses the treatment of the obese pediatric patient. Treatment can include medical therapy, pharmacotherapy, or even surgical therapy. Medical treatment is slightly different for a growing child in comparison to an adult, especially if the child is overweight or even mildly obese. If no other health concerns exist, the goal may not be weight loss, but rather weight maintenance. Pediatric patients should be screened for depression as well as sleep apnea, and referrals initiated for further counseling or testing, as needed. Prescription weight-loss medications are not often recommended for children or adolescents, as long-term side effects of many prescription medications are unknown. Patients and families should be reminded that medications do not replace healthy eating or physical activity; these should be encouraged in addition to prescription medication. Surgery is also not recommended for those who have an untreated psychiatric disorder, including an eating disorder.
Gynecologic cancers have the potential to originate from anywhere in the reproductive tract, which includes the uterus, ovaries, cervix, vulva, vagina, fallopian tubes, or peritoneum. This chapter focuses on three gynecologic cancers, namely endometrial, ovarian, and cervical carcinomas. The interested reader is referred elsewhere for a more detailed description of these cancers and for information on the other less common gynecologic malignancies. The initial treatment of endometrial cancer involves surgical staging if the patient is medically fit. Adjuvant therapy is based on several key factors, namely stage, grade, and age, with the goal of adjuvant therapy to decrease the risk of cancer recurrence. Surgery followed by postoperative chemotherapy is the standard treatment for all patients with advanced-stage epithelial ovarian cancer and for many patients with early-stage disease. Postoperative chemotherapy is known to significantly prolong survival, and the current data support the use of platinum- and taxane-based regimens.
This chapter provides a brief description on the principles of neurosurgery in cancer. Metastatic spinal tumors are a major source of morbidity in cancer patients. The overriding goals for treatment are palliative in order to improve or maintain neurological status, provide spinal stability, and achieve local, durable tumor control. The principle treatments for spinal tumors are radiation and/or surgery. Recent advances in surgical and radiation techniques, such as image-guided intensity modulated radiation therapy, have made treatment of spine metastases safer and more effective. Additionally, the development of newer chemotherapy, hormonal, and immunotherapy treatments has led to improved systemic control of many types of cancers. Rehabilitative medicine plays a large role in achieving meaningful palliation and improved quality of life for patients with spinal tumors. A fundamental understanding of treatment decisions and outcomes will help in the assessment of cancer patients.
Pulmonary disease and its complications are prevalent in the general population and are the third leading cause of death in the United States. Primary lung cancer is the leading cause of cancer death in men and women in the United States. Since the lungs are one of the primary sites of metastatic disease, morbidity caused by the secondary metastases to the lungs is also common. Further injury to the lungs may stem from the effects of treatment, including surgery, radiation therapy, chemotherapy, and from complications such as pneumonia and pulmonary embolism. Maintaining good pulmonary toilet practices, preserving overall conditioning, and focusing on strengthening and compensatory exercises will allow patients to maintain their capacity despite their condition and its complications. This chapter provides a brief description on metastatic disease, restrictive lung conditions, radiation pneumonitis, chemotherapy-induced lung injury, obstructive lung disease in cancer patients, pulmonary vascular disease, and rehabilitation treatment options.